原发性胆汁性胆管炎合并胆结石的临床特征及熊去氧胆酸治疗应答情况

Clinical characteristics of primary biliary cholangitis complicated with cholelithiasis and the response to ursodeoxycholic acid therapy

目的探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)合并胆结石和PBC未合并胆结石患者的临床特征,并比较两组患者使用熊去氧胆酸(ursodeoxycholic acid,UDCA)治疗后应答情况。方法回顾性分析2015年6月至2020年6月于空军军医大学第一附属医院就诊的1102例自身免疫性肝病(autoimmune liver disease,AILD)患者的临床资料,筛选出PBC患者872例。分析PBC合并胆结石组和PBC未合并胆结石组的基本特征、实验室检查指标情况,并比较两组患者服用UDCA治疗后肝功变化及生化应答情况。结果PBC患者合并胆结石比例为21.9%(191/872)。PBC合并胆结石组的首诊年龄、确诊时肝硬化比例较PBC未合并胆结石组高(P<0.001),且PBC合并胆结石组确诊时ALB、AST、ALT、GGT水平均较PBC未合并胆结石组低(P<0.05)。服用UDCA治疗1年后,两组肝功指标均较治疗前明显改善(P<0.05),PBC合并胆结石组AST、ALT、ALP、GGT下降程度低于PBC未合并胆结石组(P<0.05),PBC合并胆结石组生化应答率低于PBC未合并胆结石组(P<0.05)。结论PBC患者的胆结石患病率较高。PBC合并胆结石患者确诊时病情较重,治疗后生化应答率及肝功改善程度均低于PBC未合并胆结石患者。

Objective To investigate the clinical characteristics of primary biliary cholangitis(PBC)patients complicated with and without cholelithiasis,and to compare the response of PBC patients with and without cholelithiasis after ursodeoxycholic acid(UDCA)trearesponsetment.Methods The clinical data of 1102 patients with autoimmune liver disease(AILD)who were treated in the First Affiliated Hospital of Air Force Medical University from Jun.2015 to Jun.2020 were retrospectively analyzed.Among these,872 cases of PBC were screened out.The basic characteristics and laboratory test indexes of the PBC complicated with and without cholelithiasis were analyzed,and the changes of liver function and biochemical response after treatment with UDCA capsules were compared between the two groups.Results The proportion of PBC patients complicated with gallstones was 21.9%(191/872).The age at first diagnosis and the proportion of liver cirrhosis at diagnosis in the PBC complicated with cholelithiasis group were higher than those in the group without cholelithiasis(P<0.001),and the levels of ALB,AST,ALT and GGT in the PBC with cholelithiasis group at diagnosis were lower than those in the PBC without cholelithiasis group(P<0.05).Conclusion Patients with PBC have a higher prevalence of cholelithiasis.The condition of PBC patients with gallstones was more serious when diagnosed,and the biochemical response rate and liver function improvement degree after treatment were lower than PBC patients without gallstones.